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Biofeedback for treatment of awake and sleep bruxism in adults: systematic review protocol.

ABSTRACT: BACKGROUND: Bruxism is a disorder of jaw-muscle activity characterised by repetitive clenching or grinding of the teeth which results in discomfort and damage to dentition. The two clinical manifestations of the condition (sleep and awake bruxism) are thought to have unrelated aetiologies but are palliated using similar techniques. The lack of a definitive treatment has prompted renewed interest in biofeedback, a behaviour change method that uses electronic detection to provide a stimulus whenever bruxism occurs. This systematic review aims to provide a comprehensive overview of the state of research into biofeedback for bruxism; to assess the efficacy and acceptability of biofeedback therapy in management of awake bruxism and, separately, sleep bruxism in adults; and to compare findings between the two variants. METHODS: A systematic review of published literature examining biofeedback as an intervention directed at controlling primary bruxism in adults. We will search electronic databases and the grey literature using a predefined search strategy to identify randomised and non-randomised studies, technical reports and patents. Searches will not be restricted by language or date and will be expanded through contact with authors and experts, and by following up reference lists and citations. Two authors, working independently, will conduct screening of search results, study selection, data extraction and quality assessment and a third will resolve any disagreements. The primary outcomes of acceptability and effectiveness will be assessed using only randomised studies, segregated by bruxism subtype. A meta-analysis of these data will be conducted only if pre-defined conditions for quality and heterogeneity are met, otherwise the data will be summarized in narrative form. Data from non-randomised studies will be used to augment a narrative synthesis of the state of technical developments and any safety-related issues. PROSPERO registration number: CRD42013006880. DISCUSSION: Biofeedback is not new, but its place in the clinical management of bruxism remains unclear. New research, and the availability of miniaturized consumer-grade devices, makes a systematic review timely to guide treatment decisions and inform future research.

SUBMITTER: Ilovar S

PROVIDER: S-EPMC4028105 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Biofeedback for treatment of awake and sleep bruxism in adults: systematic review protocol.

Ilovar Sasa S Zolger Danaja D Castrillon Eduardo E Car Josip J Huckvale Kit K

Systematic reviews 20140502

<h4>Background</h4>Bruxism is a disorder of jaw-muscle activity characterised by repetitive clenching or grinding of the teeth which results in discomfort and damage to dentition. The two clinical manifestations of the condition (sleep and awake bruxism) are thought to have unrelated aetiologies but are palliated using similar techniques. The lack of a definitive treatment has prompted renewed interest in biofeedback, a behaviour change method that uses electronic detection to provide a stimulus ...[more]

PMID: 24886985

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Project description:PurposeThis systematic review determines the best known form of biofeedback (BF) and/or electrical stimulation (ES) for the treatment of fecal incontinence in adults and rates the quality of evidence using the Grades of Recommendation, Assessment, Development, and Evaluation. Attention is given to type, strength, and application mode of the current for ES and to safety.MethodsMethods followed the Cochrane Handbook. Randomized controlled trials were included. Studies were searched in The Cochrane Library, MEDLINE, and EMBASE (registration number (PROSPERO): CRD42011001334).ResultsBF and/or ES were studied in 13 randomized parallel-group trials. In 12 trials, at least one therapy group received BF alone and/or in combination with ES, while ES alone was evaluated in seven trials. Three (four) trials were rated as of high (moderate) quality. Average current strength was reported in three of seven studies investigating ES; only two studies reached the therapeutic window. No trial showed superiority of control, or of BF alone or of ES alone when compared with BF + ES. Superiority of BF + ES over any monotherapy was demonstrated in several trials. Amplitude-modulated medium-frequency (AM-MF) stimulation, also termed pre-modulated interferential stimulation, combined with BF was superior to both low-frequency ES and BF alone, and 50 % of the patients were continent after 6 months of treatment. Effects increased with treatment duration. Safety reporting was bad, and there are safety issues with some forms of low-frequency ES.ConclusionsThere is sufficient evidence for the efficacy of BF plus ES combined in treating fecal incontinence. AM-MF plus BF seems to be the most effective and safe treatment.Key messages• The higher the quality of the randomized trial the more likely was a significant difference between treatment groups. • Two times more patients became continent when biofeedback was used instead of a control, such as pelvic floor exercises. • Two times more patients became continent when biofeedback plus electrical stimulation was used instead of biofeedback only. • Low-frequency electrical stimulation can have adverse device effects, and this is in contrast to amplitude-modulated medium-frequency electrical stimulation. • There is high quality evidence that amplitude-modulated medium-frequency electrical stimulation plus electromyography biofeedback is the best second-line treatment for fecal incontinence.

Project description:Polypharmacy, the concurrent use of multiple medications, consistently evokes a negative connotation, notably because it is associated with a plethora of adverse events. Nonetheless, the number of individuals exposed to polypharmacy is increasing steeply, especially for older people with multiple diseases. There is a need to carefully study the phenomenon at the population scale to full assess the associated health outcomes. Yet, this reveals a complex task because there exists no consensus indicator of polypharmacy. In fact, the definitions of polypharmacy are heterogeneous and its predisposing factors and associated outcomes are not well defined. The goal of this systematic review is to summarize the literature on polypharmacy in multimorbid individuals aged 65 years and over, targeting three objectives: (1) to identify the definitions of polypharmacy that are used in the context of multimorbidity among older individuals (?65 years); (2) to ascertain predisposing and concurrent factors associated with polypharmacy; and (3) to describe positive and negative outcomes of polypharmacy among older individuals, including hospitalizations, mortality and costs.We will include publications from 2004 to 2016 that target four concepts: polypharmacy, older individuals, multimorbidity and positive/negative outcomes. The search will be performed using EBM Reviews, Embase, Global Health, MEDLINE, AgeLine, CINAHL, Health Policy Reference Center, Public Affairs Index, SocINDEX and Google Scholar. Two independent reviewers will screen the articles, extract the information and evaluate the methodological quality of included studies. The results will be presented in tables and narrative summaries will be performed. We will perform meta-analyses (objective 3) if the heterogeneity is not important.This review will help describe the various ways of conceptualizing polypharmacy and how it is associated with health outcomes. We have selected outcomes most relevant for public surveillance performed with administrative databases. Other positive and negative outcomes have been associated with polypharmacy but may not be included in the review.PROSPERO CRD42014014989.

Project description:BackgroundFrailty has been defined as a clinical syndrome of multicausal origin characterized by a reduction of physiologic reserves that increase the vulnerability of an individual to adverse outcomes such as the development of functional dependence and death. Considered one of the most important geriatric syndromes, frailty's prevention and management represent important goals for gerontology and geriatrics. Although nutrition plays an important role within the multifactorial susceptibility for this syndrome, up to the present no systematic review specifically addressed the effectiveness of nutritional interventions for the treatment of frailty. Therefore, we propose the present systematic review with the aim to assess the effectiveness of nutritional interventions for the treatment of frailty in older adults living in the community or in long-term care facilities.MethodsWe will search Medline (via Pubmed), Embase, Cinahl, Central, Lilacs, Web of Science, and sources of gray literature. We will accept trials whereby the unit of randomization consisted of individuals or clusters of individuals. Our primary outcome is all-cause mortality. Secondary outcomes are quality of life, functional status, cognitive function, frailty status, body composition, and physical activity. Risk of bias will be assessed using the Cochrane Collaboration tool. We will analyze the overall strength of the evidence for each outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. Two independent researchers will conduct all evaluations and any disagreements will be resolved through the participation of a 3rd author. If possible, we will perform random-effects meta-analyses and subgroup analyses concerning specific details of nutritional interventions (e.g., components and duration), research scenario, risk of bias, and criteria used to diagnose frailty.ConclusionIn this systematic review protocol we outline the details of the aims and methods of a systematic review on the effectiveness of nutritional interventions for the management of frailty in older adults living in the community or in long-term care facilities". We believe this wording to be more objective and balanced than the previous one. We understand that it is not ideal to propose changes to the text after manuscripts have been accepted. However, we feel that the new wording of the conclusion section of the abstract is more consistent with the overall content of the main text of the review than its previous version. Hence, we hope you may accept our request.

Dataset Information

Biofeedback for treatment of awake and sleep bruxism in adults: systematic review protocol.

Publications

Biofeedback for treatment of awake and sleep bruxism in adults: systematic review protocol.

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